Healthcare-Related Financial Burden Among Families in the U.S.: The Role of Childhood Activity Limitations and Income

This study examined the impact of childhood activity limitations on family financial burden in the U.S. We used ten complete panels (1996–2006) of the Medical Expenditure Panel Survey (MEPS) to evaluate the burden of out-of-pocket healthcare expenditures for 17,857 families with children aged 0–17 years. Multivariate generalized linear models were used to examine the relationship between childhood activity limitation status and both absolute and relative financial burden. Families of children with limitations had higher absolute out-of-pocket healthcare expenditures than families of children without limitations ($594.36 higher; p < 0.05), and were 54% more likely to experience relative burden (p < 0.05). Substantial socioeconomic disparities in financial burden were observed. Policies are needed to enable these families to access appropriate and affordable healthcare services.     

Social Studies in the Twenty-First Century

Abstract

The teaching of social studies and our journal The Social Studies (TSS) are almost a century old. They grew up together. TSS was first published in 1909, and in its pages can be seen the first mention of the term social studies as a means of teaching students history that is relevant and meaningful and incorporates the latest thinking of the social sciences. TSS was first published by Albert McKinley in Philadelphia, and he and other leading early educators, such as the Rugg brothers, were the leading proponents of this new way to teach history. In 1920, McKinley and the Ruggs were the founders of a new band of educators interested in social studies. The name of the little group was the National Council for the Social Studies (NCSS), with McKinley as president, one of the Ruggs as secretary; the minutes of those exciting early meetings of NCSS were recorded in the early issues of TSS.     

Sensitivity Analysis for Computer Model Projections of Hurricane Losses

Projecting losses associated with hurricanes is a complex and difficult undertaking that is fraught with uncertainties. Hurricane Charley, which struck southwest Florida on August 13, 2004, illustrates the uncertainty of forecasting damages from these storms. Due to shifts in the track and the rapid intensification of the storm, real-time estimates grew from 2 billion dollars to 3 billion dollars in losses late on the 12th to a peak of 50 billion dollars for a brief time as the storm appeared to be headed for the Tampa Bay area. The storm struck the resort areas of Charlotte Harbor and moved across the densely populated central part of the state, with early poststorm estimates in the 28 dollars to 31 billion dollars range, and final estimates converging at 15 billion dollars as the actual intensity at landfall became apparent. The Florida Commission on Hurricane Loss Projection Methodology (FCHLPM) has a great appreciation for the role of computer models in projecting losses from hurricanes. The FCHLPM contracts with a professional team to perform onsite (confidential) audits of computer models developed by several different companies in the United States that seek to have their models approved for use in insurance rate filings in Florida. The team's members represent the fields of actuarial science, computer science, meteorology, statistics, and wind and structural engineering. An important part of the auditing process requires uncertainty and sensitivity analyses to be performed with the applicant's proprietary model. To influence future such analyses, an uncertainty and sensitivity analysis has been completed for loss projections arising from use of a sophisticated computer model based on the Holland wind field. Sensitivity analyses presented in this article utilize standardized regression coefficients to quantify the contribution of the computer input variables to the magnitude of the wind speed.     

Should Persons with Diabetes Be Licensed to Drive Trucks?—Risk Management

How should a regulatory agency interpret a risk analysis that concludes there is a small increase in risk? The agency must decide on behalf of society whether the increased risk is large enough to justify banning the risky activity or taking some other step to lessen the risks. In a companion paper (Songer et al.), we conclude that licensing insulin using persons to drive commercial motor vehicles in interstate commerce would result in 42 additional crashes each year. Here we address risk management issues by interpreting the number of additional crashes and the relative risks of the prospective handicapped drivers. Are the number of additional crashes (42) significant? Is the increase in the annual crash risk (from 0.00785 to 0.032 for non-insulin dependent and 0.048 for insulin dependent persons) significant? Are the relative risks significant for all insulin using drivers (4.7)? For drivers with a history of severe hypoglycemic reactions (19.8)? How should society tradeoff risk increases for increases in opportunity for these handicapped persons? We review other social decisions concerning highway safety: Accepting the increasing risks of letting 16 year olds drive, allowing extremely light cars, allowing some unsafe highways, and allowing extremely unsafe driving conditions at some times of day. We conclude that the additional risks from insulin using persons are well within the current accepted range of risks. Currently, 70% of states permit insulin using persons to drive trucks within their state. Nonetheless, the social cost, due to fatalities, injuries, and property damage from allowing a person with a history of severe hypoglycemic reactions to drive is more than $19,700 per year.     

Determining attribute weights using mathematical programming

Group decisions are an important element of successful knowledge management in organizations. Such decisions are difficult to make, however, especially when they involve a large set of attributes that require decision-makers to develop rankings. This paper presents a goal programming model for determining constrained regression estimates of attribute weights. The model is developed using pair-wise comparison ratings that are derived by using triads of the attributes. In addition, metrics are presented for measuring individual and group consensus. A specific application to the health care industry is presented to illustrate results that are obtained from the model.     

Effects of neighbourhood demographic shifts on findings of environmental injustice: a New York City case-study

Summary We study the question of how changes in neighbourhood demographics affect findings of environmental equity. Many cross-sectional studies of association between neighbourhood racial and ethnic composition and the location of environmentally undesirable sites have been conducted. However, no evaluations have been conducted that examine how neighbourhood demographics change over time, and how those changes are related to the observed cross-sectional results. If the question is whether an observed association is the result of discrimination, it is crucial that the historical changes in neighbourhood structure are well understood. We develop some methods based on standard statistical techniques and illustrate their application by using the metropolitan New York City region as a case-study.     

CHALLENGES TO EU POLITICAL INTEGRATION AND THE ROLE OF DEMOCRATIZATION1

The European Union project of political integration faces three main challenges. The first concerns the constitutional make-up of the European Union as a political system. Key here is the role of subsidiarity and the question of statehood. The second challenge has to do with the opportunity structures for participation in a multilevel and supra-national context of governance. The third challenge is that of political identity. In the contemporary political debate, the first of the above challenges is discussed almost exclusively in terms of institutional mechanisms, the third in terms of symbolic identification based on culture and language. Opportunity structures for participation are thought to matter as a means of legitimacy or, alternatively, in terms of political acceptability. The underlying assumption is that policy is mainly a matter of technocratic management and politics a question of identity. This is the key problem of the contemporary discourse regarding European integration and the EU democratic deficit.